Lessons From Across the Country Improving Human Services Delivery Elysa Gordon, M.S.W., J.D., Assistant Child Advocate Christina D. Ghio, Esq., Assistant

Lessons From Across the Country

Improving Human Services Delivery

Elysa Gordon, M.S.W., J.D., Assistant Child Advocate

Christina D. Ghio, Esq., Assistant Child Advocate

Human Services in Connecticut

5 Primary Agencies Department of Social Services (DSS) Department of Mental Health and Addiction

Services (DMHAS) Department of Children and Families (DCF) Department of Developmental Services (DDS) Department of Public Health (DPH)

Total Budget (2007-2008): $7,717,282,633 Total Staff (as of June 30, 2008): 14,405

Human Services in Connecticut

Children, their families, and their caregivers receive services from all 5 agencies

OCA, consistent with its statutory mandate to evaluate the delivery of services to children, has examined inter- and intra-agency collaboration

Regions: DCF

15 area offices Plus central office and a satellite office for

special investigations, audit unit, revenue enhancement and unified school district II

Regions: DCFDCF Regions

1

2

3

4 5

6

7

8

9

10

11

12

13

14

15

Map Courtesy of CT Voices For Children

Regions: DSS

3 Regions Northern Southern Western

Regions: DDS

3 Regions North South West

Regions: DSS & DDSDSS & DDS Regions

Northern

Southern

Western


Regions: DMHAS

5 regions Region One Region Two Region Three Region Four Region Five

Regions: DMHAS

DMHAS Regions

1

2

3

4

5


Regions: DPH

DPH includes the central office and the local health administration branch (LHAB)

80 LHAB (including 32 municipalities and 20 health districts)

Regions: DPH

See Department of Public Health at https://www.han.ct.gov/local_health/images/LocalHealthMap.gif

Similar Internal Support Functions Administrative Hearings Communications Fiscal Analysis Human Resources Information Technology Legal Affairs Licensing Ombudsman Public Relations/Communications/Government Affairs Quality Management Rate Setting and Rate Enhancement Research Strategic Planning Training

Similar Services Delivered

Addiction Services Early Childhood Entitlements Housing Prevention Mental Health

Administrative Costs

Activities Defined as Administrative Costs Vary Across Federal and State Programs and Funding Streams

Administrative Costs Subject to Various Funding Rules

What Does it Mean for Consumers? Numerous Doors for Eligibility Determination Different Regions for Different Agencies Different Offices Within Regions Potential for Duplicative and Conflicting

Compliance for Services Multiple Caseworkers Multiple Chains of Command Multiple Problem Resolution Processes

What Does it Mean for Taxpayers?

Inadequate Accountability and Transparency for State Dollars Spent

Inefficient Use of State Funds

Most Vulnerable Citizens May Experience Difficulty Accessing Needed Services

Lessons From Across the Country

What Can Connecticut Learn From Other Efforts to Improve Human Services Delivery?

Lessons From Across The Country Success Requires:

Strong and Visible Executive Leadership Money to Invest

Data Collection and Analysis Technology Integration Retraining and Cross-training

Measurable Outcomes Tied to Budgeting Time (3-5 years minimum)

See David Osborne, The Reinventor's Fieldbook: Tools for Transforming Your Government (2000); David Osborne, Banishing Bureaucracy: The Five Strategies For Reinventing Government (1997); Stewards of Change, Inc., Building an Interoperable Human Services System (2008)

Case Study: Allegheny County Department of Human Services

Transformation of a widely criticized system of siloed services into a single Department of Human Services based on innovative business concepts and integrated technology


Over a Decade of Transformation 1996- Present

Catalyst for Change: Child fatality and chronic systemic failure of the

Department of Children and Youth Services (CYS)

Acknowledged lack of coordination among human services agencies

A vision to streamline county government

Case Study: Allegheny County Department of Human Services Leadership at All Levels

Independent Blue Ribbon Commission created by county Board of Commissioners with leaders from academia, business, philanthropy, and the judiciary

National search launched immediately after resignation of CYS Director in early 1995 to “overhaul the agency”

Blue Ribbon Commission created roadmap to guide reform at CYS and a roadmap to create a new integrated Department of Human Services (DHS)


Transformed from six County Departments into five DHS program offices Area Agency on Aging Office of Behavioral Health Office of Children, Youth and Families Office of Community Services Office of Mental Retardation/Developmental

Disabilities


Consolidated Internal Support (“Back Office”) Functions Office of Administration Office of Community Relations Office of Policy, Information, Planning,

Evaluation and Research

Case Study: Allegheny County Department of Human Services New Leadership at CYS and DHS

Convened stakeholders including consumers, foundations, universities, business leaders, and providers

Elicited funding and in-kind supports from local philanthropic, business, and academic communities

CYS shifted focus to family preservation and unification, allowing reallocation of resources to prevention

DHS enhanced revenue by pursuing uncapped federal entitlements


New Leadership at CYS and DHS

Integrated data through the creation of Data Warehouse Central repository of human services data to

support clinical and policy decision-making Information sharing

Concepts from Stewards of Change, Inc.

National consulting group that studies the integration of human services delivery and assists states with integration initiatives to improve the outcomes of the children and families they serve

Stewards of Change, Inc. www.stewardsofchange.org

Stewards of Change

Core principles:

Interoptimability: The Vision

Interoperability: The Technology to Facilitate and Support the Vision


InterOptimability

Creating a Consumer-Centric Focus Bridging and Integrating Service Silos Managing Confidentiality Restructuring Workforce and Training Interoperable Technology Framework


Interoperability

Using information technology (IT) across human services systems to share and use information to improve efficiency of multiple systems and outcomes for children and families

Breaking down social service system silos

Eliminating duplication of services and staff

Increasing coordination among human services agencies to increase access to services and maximize taxpayer dollars


Next Steps for Connecticut

Identify cost neutral or cost saving actions that can set the groundwork for transforming human services delivery

Next Steps Develop Partnerships to Set a Vision and Support

Transformation Academia Business Community Judicial Key Constituencies

Consumers Providers Advocates

Law Enforcement Philanthropic Community

Next Steps

Develop population-based outcome measures for which the human services agencies are jointly responsible

http://benchmarks.oregon.gov/default.aspx http://www.resultsiowa.org/department_performanc

e.html

Next Steps Consolidate Internal Support (“Back Office”)

Functions Administrative Hearings Communications Fiscal Human Resources Information Technology Legal Affairs Licensing Ombudsman Public Relations/Communications/Government Affairs Quality Management Training

Next Steps

Create a single point of entry or no wrong door system for eligibility determination and information about available services

Next Steps

Maximize federal revenues

Encourage agencies to save money by allowing them to reinvest all or a percentage of the savings to sustain or expand programs/direct services

Next Steps

De-layer Management

Identify layers that can be reduced or eliminated without impacting services

Increase supervisor to staff ratios where possible while ensuring best practice for service delivery

CONCLUSION

Accessing Resources for Connecticut Connecticut Consumers, Providers,

Advocates, and Leaders in Business, Academia, and Philanthropy

Stewards of Change, Inc. Marc Cherna, Allegheny County Casey Family Programs

Documents

Lessons From Across the Country Improving Human Services Delivery Elysa Gordon, M.S.W., J.D., Assistant Child Advocate Christina D. Ghio, Esq., Assistant